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Arias de la Rosa I, Font P, Escudero-Contreras A, López-Montilla MD, Pérez-Sánchez C, Ábalos-Aguilera MC, Ladehesa-Pineda L, Ibáñez-Costa A, Torres-Granados C, Jimenez-Gomez Y, Patiño-Trives A, Luque-Tévar M, Castro-Villegas MC, Calvo-Gutiérrez J, Ortega-Castro R, López-Pedrera C, Collantes-Estévez E, Barbarroja N. Complement component 3 as biomarker of disease activity and cardiometabolic risk factor in rheumatoid arthritis and spondyloarthritis. Ther Adv Chronic Dis 2021; 11:2040622320965067. [PMID: 33796240 PMCID: PMC7983248 DOI: 10.1177/2040622320965067] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/18/2020] [Indexed: 01/12/2023] Open
Abstract
Objective To analyze the relationship between complement component 3 (C3) and the prevalence of cardiometabolic risk factors and disease activity in the rheumatic diseases having the highest rates of cardiovascular morbidity and mortality: rheumatoid arthritis (RA), psoriatic arthritis (PsA) and axial spondyloarthritis (axSpA). Methods This is a cross-sectional study including 200 RA, 80 PsA, 150 axSpA patients and 100 healthy donors. The prevalence of cardiometabolic risk factors [obesity, insulin resistance, type 2 diabetes mellitus, hyperlipidemia, apolipoprotein B/apolipoprotein A (apoB/apoA) and atherogenic risks and hypertension] was analyzed. Serum complement C3 levels, inflammatory markers and disease activity were evaluated. Cluster analysis was performed to identify different phenotypes. Receiver operating characteristic (ROC) curve analysis to assess the accuracy of complement C3 as biomarker of insulin resistance and disease activity was carried out. Results Levels of complement C3, significantly elevated in RA, axSpA and PsA patients, were associated with the prevalence of cardiometabolic risk factors. Hard clustering analysis identified two distinctive phenotypes of patients depending on the complement C3 levels and insulin sensitivity state. Patients from cluster 1, characterized by high levels of complement C3 displayed increased prevalence of cardiometabolic risk factors and high disease activity. ROC curve analysis showed that non-obesity related complement C3 levels allowed to identify insulin resistant patients. Conclusions Complement C3 is associated with the concomitant increased prevalence of cardiometabolic risk factors in rheumatoid arthritis and spondyloarthritis. Thus, complement C3 should be considered a useful marker of insulin resistance and disease activity in these rheumatic disorders.
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Affiliation(s)
- Iván Arias de la Rosa
- Medicine Department, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, Cordoba, Spain
| | - Pilar Font
- Medicine Department, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital, Cordoba, Spain
| | | | | | - Carlos Pérez-Sánchez
- Department of Medicine, University of Cambridge School of Clinical Medicine, Cambridge Biomedical Campus, Cambridge, UK
| | | | - Lourdes Ladehesa-Pineda
- Rheumatology service, IMIBIC, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Alejandro Ibáñez-Costa
- Rheumatology service, IMIBIC, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Carmen Torres-Granados
- Rheumatology service, IMIBIC, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Yolanda Jimenez-Gomez
- Rheumatology service, IMIBIC, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Alejandra Patiño-Trives
- Rheumatology service, IMIBIC, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - María Luque-Tévar
- Rheumatology service, IMIBIC, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | | | - Jerusalem Calvo-Gutiérrez
- Rheumatology service, IMIBIC, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Rafaela Ortega-Castro
- Rheumatology service, IMIBIC, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Chary López-Pedrera
- Rheumatology service, IMIBIC, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Eduardo Collantes-Estévez
- Rheumatology service, IMIBIC, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Nuria Barbarroja
- Medicine Department, University of Cordoba, Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), Reina Sofia University Hospital
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Pérez-Sánchez C, Ruiz-Limón P, Aguirre MA, Jiménez-Gómez Y, Arias-de la Rosa I, Ábalos-Aguilera MC, Rodriguez-Ariza A, Castro-Villegas MC, Ortega-Castro R, Segui P, Martinez C, Gonzalez-Conejero R, Rodríguez-López S, Gonzalez-Reyes JA, Villalba JM, Collantes-Estévez E, Escudero A, Barbarroja N, López-Pedrera C. Diagnostic potential of NETosis-derived products for disease activity, atherosclerosis and therapeutic effectiveness in Rheumatoid Arthritis patients. J Autoimmun 2017; 82:31-40. [PMID: 28465139 DOI: 10.1016/j.jaut.2017.04.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/21/2017] [Accepted: 04/21/2017] [Indexed: 12/23/2022]
Abstract
OBJECTIVES 1) To assess the association of NETosis and NETosis-derived products with the activity of the disease and the development of cardiovascular disease in RA; 2) To evaluate the involvement of NETosis on the effects of biologic therapies such as anti-TNF alpha (Infliximab) and anti-IL6R drugs (Tocilizumab). METHODS One hundred and six RA patients and 40 healthy donors were evaluated for the occurrence of NETosis. Carotid-intimae media thickness was analyzed as early atherosclerosis marker. Inflammatory and oxidative stress mediators were quantified in plasma and neutrophils. Two additional cohorts of 75 RA patients, treated either with Infliximab (n = 55) or Tocilizumab (n = 20) for six months, were evaluated. RESULTS NETosis was found increased in RA patients, beside myeloperoxidase and neutrophil elastase protein levels. Cell-free nucleosomes plasma levels were elevated, and strongly correlated with the activity of the disease and the positivity for autoantibodies, alongside inflammatory and oxidative profiles in plasma and neutrophils. Moreover, ROC analyses showed that cell-free nucleosomes levels could identify RA patients showing early atherosclerosis with high specificity. RA patients treated either with IFX or TCZ for six months exhibited decreased generation of NETs. Concomitantly, clinical parameters and serum markers of inflammation were found reduced. Mechanistic in vitro analyses showed that inhibition of NETs extrusion by either DNase, IFX or TCZ, further abridged the endothelial dysfunction and the activation of immune cells, thus influencing the global activity of the vascular system. CONCLUSIONS NETosis-derived products may have diagnostic potential for disease activity and atherosclerosis, as well as for the assessment of therapeutic effectiveness in RA.
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Affiliation(s)
- C Pérez-Sánchez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain
| | - P Ruiz-Limón
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain; Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Spain
| | - M A Aguirre
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain; Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain; Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Spain
| | - Y Jiménez-Gómez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain; Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Spain
| | - I Arias-de la Rosa
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain
| | | | - A Rodriguez-Ariza
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain
| | - M C Castro-Villegas
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain; Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - R Ortega-Castro
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain; Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - P Segui
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain
| | - C Martinez
- Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Spain
| | - R Gonzalez-Conejero
- Centro Regional de Hemodonación, Universidad de Murcia, IMIB-Arrixaca, Spain
| | - S Rodríguez-López
- Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Campus de Excelencia Internacional Agroalimentario, ceiA3, Córdoba, Spain
| | - J A Gonzalez-Reyes
- Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Campus de Excelencia Internacional Agroalimentario, ceiA3, Córdoba, Spain
| | - J M Villalba
- Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Campus de Excelencia Internacional Agroalimentario, ceiA3, Córdoba, Spain
| | - E Collantes-Estévez
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain; Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain; Departamento de Medicina (Medicina, Dermatología y Otorrinolaringología), Universidad de Córdoba, Spain
| | - A Escudero
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain; Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - N Barbarroja
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain
| | - Ch López-Pedrera
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Spain; Unidad de Gestión Clínica Reumatología, Hospital Universitario Reina Sofía, Córdoba, Spain.
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Cárdenas M, de la Fuente S, Font P, Castro-Villegas MC, Romero-Gómez M, Ruiz-Vílchez D, Calvo-Gutiérez J, Escudero-Contreras A, Casado MA, Del Prado JR, Collantes-Estévez E. Real-world cost-effectiveness of infliximab, etanercept and adalimumab in rheumatoid arthritis patients: results of the CREATE registry. Rheumatol Int 2016; 36:231-41. [PMID: 26494567 DOI: 10.1007/s00296-015-3374-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/25/2015] [Indexed: 12/27/2022]
Abstract
Biological drugs have proven efficacy and effectiveness in treatment of rheumatoid arthritis (RA), although none has been shown to be superior. Few studies have evaluated the cost-effectiveness of biological drugs in real-life clinical conditions. The objective of this study was to compare the cost-effectiveness of infliximab, etanercept and adalimumab in achieving clinical remission (DAS28 < 2.6) when used as initial biological therapy. Patients were diagnosed with RA who began treatment with infliximab, etanercept or adalimumab in the Reina Sofia Hospital (Cordoba, Spain) between January 1, 2007, and December 31, 2012. Effectiveness was measured as the percentage of patients who achieved clinical remission after 2 years. The cost analysis considered the use of direct health resources (perspective of the healthcare system). Cost-effectiveness was calculated by dividing the total mean cost of each treatment by the percentage of patients who achieved remission. One hundred and thirty patients were included: 55 with infliximab, 44 with adalimumab and 31 with etanercept. After 2 years, 45.2 % of patients with adalimumab achieved clinical remission, versus 29.1 % with infliximab (p = 0.133) and 22.7 % with etanercept (p = 0.040), with no differences between etanercept and infliximab (p = 0.475). The average total cost at 2 years was €29,858, €25,329 and €23,309 for adalimumab, infliximab and etanercept, respectively, while the mean cost (95 %CI) to achieve remission was €66,057 (48,038–84,076), €87,040 (78,496–95,584) and €102,683 (94,559–110,807), respectively. Adalimumab was more efficient than etanercept (p < 0.001) and infliximab (p = 0.026), with no differences between etanercept and infliximab (p = 0.086). Adalimumab was the most cost-effective treatment in achieving clinical remission in real-life clinical conditions in RA patients during the study period.
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Cárdenas M, de la Fuente S, Castro-Villegas MC, Romero-Gómez M, Ruiz-Vílchez D, Calvo-Gutiérrez J, Escudero-Contreras A, Del Prado JR, Collantes-Estévez E, Font P. Cost-effectiveness of clinical remission by treat to target strategy in established rheumatoid arthritis: results of the CREATE registry. Rheumatol Int 2016; 36:1627-1632. [PMID: 27778067 DOI: 10.1007/s00296-016-3583-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 10/19/2016] [Indexed: 12/16/2022]
Abstract
To analyse the cost-effectiveness, in daily clinical practice, of the strategy of treating to the target of clinical remission (CR) in patients with established rheumatoid arthritis (RA), after 2 years of treatment with biological therapy. Adult patients with established RA were treated with biological therapy and followed up for 2 years by a multidisciplinary team responsible for their clinical management. Treatment effectiveness was evaluated by the DAS28 score. The direct costs incurred during this period were quantified from the perspective of the healthcare system. We calculated the cost-effectiveness of obtaining a DAS28 < 2.6, considered as CR. The study included 144 RA patients treated with biological therapies. After 2 years of treatment, 32.6% of patients achieved CR. The mean cost of achieving CR at 2 years was 79,681 ± 38,880 euros. The strategy of treatment to the target of CR is considered the most effective, but in actual clinical practice in patients with established RA, it has a high cost.
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Affiliation(s)
- M Cárdenas
- Pharmacy Department, Reina Sofía Universitary Hospital, University of Córdoba, Córdoba, Spain.
| | - S de la Fuente
- Pharmacy Department, Reina Sofía Universitary Hospital, University of Córdoba, Córdoba, Spain
| | - M C Castro-Villegas
- Rheumatology Department, Reina Sofía Universitary Hospital, IMIBIC/University of Córdoba, Córdoba, Spain
| | - M Romero-Gómez
- Rheumatology Department, Reina Sofía Universitary Hospital, IMIBIC/University of Córdoba, Córdoba, Spain
| | - D Ruiz-Vílchez
- Rheumatology Department, Reina Sofía Universitary Hospital, IMIBIC/University of Córdoba, Córdoba, Spain
| | - J Calvo-Gutiérrez
- Rheumatology Department, Reina Sofía Universitary Hospital, IMIBIC/University of Córdoba, Córdoba, Spain
| | - A Escudero-Contreras
- Rheumatology Department, Reina Sofía Universitary Hospital, IMIBIC/University of Córdoba, Córdoba, Spain
| | - J R Del Prado
- Pharmacy Department, Reina Sofía Universitary Hospital, University of Córdoba, Córdoba, Spain
| | - E Collantes-Estévez
- Rheumatology Department, Reina Sofía Universitary Hospital, IMIBIC/University of Córdoba, Córdoba, Spain
| | - P Font
- Rheumatology Department, Reina Sofía Universitary Hospital, IMIBIC/University of Córdoba, Córdoba, Spain
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Calvo-Gutiérrez J, Garrido-Castro JL, González-Navas C, Castro-Villegas MC, Ortega-Castro R, López-Medina C, Font-Ugalde P, Escudero-Contreras A, Collantes-Estévez E. Inter-rater reliability of clinical mobility measures in ankylosing spondylitis. BMC Musculoskelet Disord 2016; 17:382. [PMID: 27596243 PMCID: PMC5011978 DOI: 10.1186/s12891-016-1242-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 09/02/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Several measurements are often used in daily clinical practice in the assessment of Ankylosing Spondylitis (AS) patients. The Assessment in SpondyloArthiritis International Society (ASAS) recommend in its core set: chest expansion modified Schöber test, Occiput to wall distance, lateral lumbar flexion, cervical rotation and The Bath Ankylosing Spondylitis Metrology Index (BASMI). BASMI also includes five measurements, some of them recommended by ASAS. Three versions of BASMI have been published with different scales and intervals for each component of the index. Though studies about reliability of these measurements are needed. The aim of this study was to analyze inter-rater reliability of recommended spinal mobility measures in AS. METHODS We examined reproducibility of spinal mobility measurements on 33 AS patients performed by two experienced rheumatologists in the same day. Descriptive statistics, Intraclass Correlation Coefficients (ICC), and Smallest Detectable Difference (SDD) using the Bland-Altman criteria were obtained for all the measurements. RESULTS Chest expansion showed the lowest value of ICC (0.66) and occiput-wall the highest (0.97). SDD was 2.43 units for BASMI2 and 1.27 units for BASMI10. CONCLUSIONS Reliability according to ICC was moderate to high in all measurements. BASMI10, instead BASMI2, must be used: measurements used to calculate are the same but there is better reliability. Inter-rater variation, expressed as SDD, must be taken in account: smaller improvements do not demonstrate the efficacy of treatment because they can be due to experimental error and not to the treatment itself.
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Affiliation(s)
- J Calvo-Gutiérrez
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), University of Cordoba, Av/ Menedez Pidal SN, 14001, Cordoba, Spain.
| | - J L Garrido-Castro
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), University of Cordoba, Av/ Menedez Pidal SN, 14001, Cordoba, Spain
| | - C González-Navas
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), University of Cordoba, Av/ Menedez Pidal SN, 14001, Cordoba, Spain
| | - M C Castro-Villegas
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), University of Cordoba, Av/ Menedez Pidal SN, 14001, Cordoba, Spain
| | - R Ortega-Castro
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), University of Cordoba, Av/ Menedez Pidal SN, 14001, Cordoba, Spain
| | - C López-Medina
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), University of Cordoba, Av/ Menedez Pidal SN, 14001, Cordoba, Spain
| | - P Font-Ugalde
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), University of Cordoba, Av/ Menedez Pidal SN, 14001, Cordoba, Spain
| | - A Escudero-Contreras
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), University of Cordoba, Av/ Menedez Pidal SN, 14001, Cordoba, Spain
| | - E Collantes-Estévez
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), University of Cordoba, Av/ Menedez Pidal SN, 14001, Cordoba, Spain
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Cárdenas M, Font P, De la Fuente S, Castro-Villegas MC, Romero-Gómez M, Ruiz-Vílchez D, Escudero A, Ortega-Castro R, Calvo-Gutiérrez J, Collantes-Estévez E. CP-078 Optimisation of biological therapy in established rheumatoid arthritis patients in real life clinical practice. Eur J Hosp Pharm 2016. [DOI: 10.1136/ejhpharm-2016-000875.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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